心脏起搏器安装病人术后卧床时间的探讨

心脏起搏器是以一定强度和频率的脉冲电流刺激心脏，使起搏或传导功能障碍的心脏能够激动，并以一定的频率有效地收缩。为避免电极移位和导管脱离，通常术后让病人绝对卧床3d～7d，因此，病人常产生便秘、腹胀等不适，心理压力也很大。自2002年6月开始我们采用固定术侧肩肘关节的方法，病人术后6h即可取半卧位，24h后开始下床活动，减轻了病人因生活习惯改变而引起的不适，未出现电极移位现象。     

起搏器置入术后体位和卧床时间探讨

[目的]探讨安装起搏器病人术后卧床时间。[方法]实验组术后4h～6h取半卧位,12h后下床活动。对照组术后卧床3d～7d,观察两组病人术后并发症发生情况。[结果]实验组拆线时间提前,术后病人腹胀、便秘发生率明显低于对照组(P<0.01)。[结论]起搏器置入术后缩短卧床时间,有利于切口愈合,减少并发症的发生。     

心脏起搏器安装病人术后卧床时间的探讨

心脏起搏器是以一定强度和频率的脉冲电流刺激心脏 ,使起搏或传导功能障碍的心脏能够激动 ,并以一定的频率有效地收缩。为避免电极移位和导管脱离 ,通常术后让病人绝对卧床3d～ 7d[1] ,因此 ,病人常产生便秘、腹胀等不适 ,心理压力也很大。自 2 0 0 2年 6月开始我们采用固定术侧肩肘关节的方法 ,病人术后 6h即可取半卧位 ,2 4h后开始下床活动 ,减轻了病人因生活习惯改变而引起的不适 ,未出现电极移位现象。1　一般资料　　实验组为 2 0 0 2年 6月— 2 0 0 3年 6月住院的病人共 3 5例 ,其中男 2 5例 ,女 10例 ,年龄 5 1岁～ 89岁 ,平均年龄 6…     

起搏器置入术后体位和卧床时间探讨

[目的]探讨安装起搏器病人术后卧床时间。[方法]实验组术后4h～6h取半卧位,12h后下床活动。对照组术后卧床3d～7d,观察两组病人术后并发症发生情况。[结果]实验组拆线时间提前,术后病人腹胀、便秘发生率明显低于对照组（P〈0.01）。[结论]起搏器置入术后缩短卧床时间,有利于切口愈合,减少并发症的发生。     

安装永久性人工心脏起搏器术后病人的康复指导

１９９１～２０００年我院对２２例安装永久性人工心脏起搏器病人进行康复指导，获得满意效果。１对象与方法本组２２例，男１２例，女１０例，年龄５０～８９岁。其中Ⅲ度房室传导阻滞１２例，病态窦房结综合征８例，其他２例。方法：（１）术后康复：术后嘱病人绝对卧床１周。术后前３d要求绝对平卧于床上，除可略微偏右卧位和下肢活动以及抬高床头外，禁忌右侧卧位、过剧翻身及右侧上肢的过度外伸外展。３d后可略微做上肢活动和轻度翻身。１周拆线后方可下床活动。在绝对卧床期间，协助病人在床上大小便以减少病人自身活动。每日以湿热毛…     

56例膝关节镜手术病人的护理

目的 探讨膝关节镜手术后病人的下床活动及负重时间。方法 对2001年1月至2002年1月我科56例患者采用膝关节镜手术后康复情况的回顾分析。结果半月板修整，切除者，术后3天扶拐下床，7天后负重；骨性关节炎及游离体摘除者，术后7天扶拐下床，15天后负重，交叉韧带损伤病人术后7-10天扶拐下床，45天后负重；结论膝关节镜手术后缩短了病人的卧床时间，是一种值得推广的治疗方法。     

早期介入运动方法对产后功能恢复的疗效观察

剖宫产术是妇产科最常见的手术，传统的观念及治疗方法认为，产妇本身体虚弱加之手术，病人应卧床时间长一些，尽量减少活动。由于长时间卧床给产妇带来不利影响，出现头晕、腹胀、便秘、乳汁分泌减少、下肢静脉血栓、关节韧带松弛等并发症心里压力很大，机体恢复较慢。自１９９９年１２月～２００１年１２月根据手术病人的自身情况，制定了一套运动方法，在病人术后４～６h开始实施，取得了满意的效果，明显减少了手术后并发症的发生。现报告如下。１对象与方法１．１对象１９９７年１月～１９９９年１１月行剖宫产手术病人３２４例为对照…     

永久心脏起搏器安置术后体位和卧床时间的探讨

目的:探讨永久心脏起搏器安置术后体位和卧床时间与患者舒适度的关系。方法:随机将290例行永久心脏起搏器安置术后的患者分为对照组87例和观察组203例。对照组采用常规护理方法,观察组采用护理人员指导患者进行术后体位的改变,调整术后卧位时间。结果:两组电极移位、出血和血肿的发生率无显著差异(P0.05);对照组发生烦躁80例,腰酸背痛82例,尿潴留7例,便秘3例,肩周炎2例;观察组发生烦躁2例,腰酸背痛1例,无尿潴留、肩周炎和便秘发生,两组比较有显著差异(P0.01,P0.05)。结论:术后改变患者的体位,缩短卧床时间,可以大大提高患者的舒适度,减少尿潴留、肩周炎、便秘、腰背酸痛、烦躁的发生率,不会增加电极移位、出血和血肿的发生率。     

品管圈应用于胃肠道肿瘤病人术后早期下床活动的效果评价

[目的]探讨品管圈在普外科胃肠道肿瘤病人术后早期下床活动中的应用效果。[方法]成立品管圈,通过品管圈活动步骤,运用自制查检表调查胃肠道肿瘤病人术后早期下床活动的影响因素,采取相应措施协助病人术后早期下床活动,并对品管圈应用前后病人术后卧床时间进行比较。[结果]开展品管圈活动后胃肠道肿瘤病人术后首次下床活动时间较之前提前(P0.01)。[结论]运用品管圈促进胃肠道肿瘤病人术后早期下床活动,缩短了术后卧床时间,加快了病人术后康复。     

早期下床对起搏器植入术后并发症影响的Meta分析

目的:通过循证护理方法,将起搏器植入术后患者早期下床对并发症的影响进行Meta分析,得出患者最佳下床活动时间。方法:检索英文数据库Cochrane library、Pubmed、ENBASE、web of science及中文数据库CNKI、维普、万方,检索时限均从建库至2017年3月;纳入起搏器植入术后实验组卧床3~6 h后下床活动、对照组卧床24 h后下床活动的RCT文献,采用Revman 5.0软件对数据进行分析。结果:最终纳入6篇文献,704例患者;实验组与对照组相比,患者囊袋积血、电极脱位发生率及舒适度评分均无统计学差异(P0.05);术侧关节僵硬疼痛、腰背酸痛、尿潴留及便秘发生率有统计学差异(P0.05)。结论:起搏器植入术后,患者卧床3~6 h后下床活动不会增加囊袋积血、电极脱位的危险性,可以减轻患者关节麻木、腰背酸痛,降低尿潴留和便秘的发生率,增加患者的舒适性。     

安装人工永久心脏起搏器术后康复护理

目的：为找出安装人工永久心脏起搏器术的最佳康复时间和制定有效的康复指标。方法：对３８例安装人工永久心脏起搏器病人进行康复研究，将病人随机分成Ａ、Ｂ两组，Ａ组按康复计划进行护理，Ｂ组按一般护理进行。结果：Ａ组出现电极脱位、腹胀、便秘、程序改变、食欲下降等并发症明显少于Ｂ组（Ｐ＜０．０５），伤口拆线时间Ａ组比Ｂ组提前１ｄ。结论：按康复计划进行护理，可缩短卧床时间，防止感染，减少并发症，有效防止电极脱位，提高病人生活质量。     

Venous Obstruction in Permanent Pacemaker Patients: An Isotopic Study

Isotope venography was used to study the venous circulation proximal to the superior vena cava in two groups of pacemaker patients, one with a single endocavitary electrode and the other with multiple pacing catheters. A control group of patients without pacemakers was also studied. Numerous abnormalities were found, especially in the group with multiple electrodes. These findings suggest that venous obstruction is a common complication of endocardial pacing.     

心脏起搏器的临床应用经验

随着人工心脏起搏器植入研究的发展，起搏器植入的适应证也不断扩展，我们植入的起搏器５７例为右心室起搏，３例为房室顺序起搏，２例为右心室心起搏及频率反应性起搏。有２例出现合并症，１例为术后３天电极脱位；１例起搏器外露，经再次植入起搏良好。急性心肌梗死患者若有植入起搏器指征时．要根据梗死部位来抉择植入的时间。     

A Comparative Evaluation of a Minute Ventilation Sensing and Activity Sensing Adaptive-Rate Pacemakers During Daily Activities

Most studies evaluating the rate response of adaptive-rate pacemakers have been based on treadmill or bicycle exercise. These studies disregard the fact that few pacemaker recipients voluntarily undertake such activities. The rate responses of nine patients (mean age 62 years, range 33-79 years) with implanted minute ventilation sensing (Meta) pacemakers were studied. The indications for pacing were complete heart block (seven patients), sick sinus syndrome (one patient), and five nodal disease (one patient). Significant improvement in maximum distance covered during a 12-minute walking test was observed in the rate adaptive compared to the VVI pacing mode (989 +/- 104 vs 921 +/- 90 m, P less than 0.02). The rate responses of this pacemaker during daily activities were recorded with telemetry during a variety of structured daily activities. The rate responses were also compared to those of an externally attached Activitrax pacemaker in each patient and to a group of ten age and sex matched volunteers. For less strenuous activities such as walking, descending stairs, washing, and bed making, both pacemakers achieved adequate rate responses compared to normal subjects. For more strenuous activities, the Activitrax pacemaker failed to achieve an adequate rate response. For example, the pacing rate achieved on ascending stairs was lower than that achieved on descending stairs (92 +/- 3 vs 102 +/- 3 bpm, P less than 0.02). The direction of rate responses was more appropriate for the Meta pacemaker. Similar to the normal subjects, the maximum rate was reached before the end of an activity with the Activitrax pacemaker.(ABSTRACT TRUNCATED AT 250 WORDS)     

Late displacement of a ventricular pacing lead after respiratory therapy

This article presents a case of displacement of the ventricular electrode of a DDD pacemaker occurring 3 years after implantation following a session of respiratory therapy. The incident provoked the loss of the ventricular pacing and left pectoral stimulation. The different techniques for achieving airway patency that can be used in respiratory therapy of patients with permanent pacemakers are discussed.     

Pacemaker therapy for early and late sinus node dysfunction in orthotopic heart transplant recipients: a single-center experience

Background: Sinus node dysfunction (SND) is a well-known early complication of orthotopic heart transplantation (OHT). Its incidence over the lifetime of transplant recipients is less well characterized. The goal of this study was to determine the incidence and timing of SND treated with a permanent pacemaker in a large cohort of OHT recipients.
Methods: The databases of the Yale University Heart Transplant and Electrophysiology Services were reviewed and cross referenced. Patients who received pacemakers for SND were identified for analysis. A total of 241 patients underwent OHT using biatrial anastamoses from 1984 to 2006. Two hundred sixteen patients, 149 men and 55 women, mean age 50.2 ± 11.6 years, survived > 5 days post-OHT. These, minus 12 lost to follow-up, were included in the analysis.
Results: These 204 patients were followed in the Yale Heart Transplant Clinic and had yearly electrocardiograms and 24-hour ambulatory monitoring. Of these patients, 24 (four female, 20 male, mean age at transplant 49 ± 12 years) were felt to have clinically significant SND and received a pacemaker. Fourteen patients received pacemakers within 30 days of OHT; 10 patients received pacemakers 45 to 4,329 days after OHT.
Conclusions: Although frequently seen as an early complication of OHT, SND remains a risk throughout the lifetime of OHT recipients. Its mechanism is likely multifactorial, and whether this risk can be mitigated over the long term by newer techniques such as bicaval anastamoses remains to be established.     

Pacemaker Function During Radiofrequency Ablation

There are increasing numbers of radiofrequency current ablation procedures being reported. Selected patients have antitachycardia or antibradycardia pacemakers. The pacemaker behavior during and after ablation procedures differs widely. We report on the pacemaker reaction of 25 patients with 13 different devices, most with unipolar electrodes. Sensing failures were observed in 8 (32.0%) and pacing failures in 4 (16.0%) patients. Prolonged pauses and induction of tachyarrhythmias were observed. No pacemaker damage was seen although it is reported by other investigators. We recommend deactivation of implanted generators and an external bipolar pacing electrode. Manufacturers should focus their attention on this problem and protect the generators and their functions for 500 kHz radiofrequency current.     

The Use and Interaction of Permanent Pacemakers and the Automatic Implantable Cardioverter Defibrillator

The adverse interactions of permanent pacemakers and automatic implantable cardioverter defibrillators (AICD) were studied in nine patients in whom both devices were implanted. Both unipolar and bipolar pacemakers were evaluated. The permanent pacemakers were also used to do noninvasive electrophysiological studies and to induce ventricular fibrillation. Undersensing of ventricular fibrillation by the permanent pacemakers caused inappropriate pacemaker stimuli, which caused undersensing of ventricular fibrillation by the AICD in three of four patients with unipolar pacemakers. After an AICD discharge, pacemaker noncapture was seen in eight of 22 episodes for an average 4.9 seconds and inability to sense was seen in 11 of 20 episodes for an average 9.0 seconds. Counting of pacemaker stimuli and QRS by the AICD caused inappropriate discharges. Noninvasive electrophysiological testing by the pacemakers correlated with invasive testing. Furthermore, induction of ventricular fibrillation was successful in four of five patients attempted, though requiring long bursts at high outputs at the shortest cycle lengths obtainable by these pacemakers. Operation of the AICD and permanent pacemakers must be clearly understood to avoid adverse interactions of these devices.     

Electronic Article Surveillance: A Possible Danger for Pacemaker Patients

In order to evaluate if antitheft devices commonly designed as electronic article surveillance (EAS) systems can be dangerous for pacemaker patients, in vitro and in vivo studies were made in close cooperation between a pacemaker center and an EAS designer. Three types of EAS radiation including radiofrequency, magnetic, and pulsed electromagnetic fields were applied to various pacemakers. The in vitro study consisted of exposing to the EAS fields 28 pacemakers connected to unipolar leads. Radiofrequency fields and pulsed electromagnetic fieids evoked minor effects and no prolonged inhibitions. When exposed to magnetic fields, most of the pacemakers switched to "fixed rate" pacing, but inhibitions were observed in 13 pacemakers exposed to 300 Hz, and in 14 pacemakers exposed to a 10-kHz magnetic field when they were moved at cardiac frequencies within the fields. The in vivo study was made on 32 volunteers treated by 26 different pacemakers: 22 single chamber and ten dual chamber. All patients had been monitored in the pacemaker clinic and pacemakers were working well. Radiofrequency and pulsed electromagnetic fields did not affect the pacemaker function. Magnetic interference evoked prolonged inhibition of seven out of the ten dual chamber pacemakers, causing brief asystole in patients being continually paced. None of the dual chamber pacemakers incorporated "safety stimulation intervals" after ventricular bianking. The EAS artifact was sensed after the ventricular blanking causing a cross-talk ECG pattern. No reprogramming was induced by the electromagnetic fields. This experience demonstrates that certain EAS may be dangerous for pacemaker patients. Following this cooperative study a pacemaker safe EAS circuit delivering short bursts of magnetic fields has been designed.     

Vacuum‐Assisted Wound Closure for Pacemaker Infection

Background: Although infection is a serious complication of pacemaker implantation, optimal treatment of infections related to pacemaker systems is poorly defined. Methods: We describe a man in his 60s, an octogenarian, and two nonagenarian females who were treated for an infected permanent pacemaker. All of these patients developed inflammation that presented as local symptoms and purulent collection in the pockets of their implanted pacemakers. After fenestration of the pacemaker pockets, they were treated with vacuum‐assisted wound closure (VAC). Results: Infection was eradicated in all the patients without the need for aggressive surgery. The open wound was re‐sutured without complete removal of the pacemaker system in two patients. After removing the infected generator from the other two patients, the open wounds healed with or without re‐suture. The mean duration of VAC was 19.5 days. The postoperative course of all of the patients was uneventful, and they remained completely asymptomatic after VAC, with no evidence of recurrent infection for 5– 15 months after discharge. Conclusions: When the risk of total system explantation is high, less‐invasive VAC might serve as the option for treating an infected pacemaker. (PACE 2010; 426–430)